Individual
DR. ADAM FASOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1330 EXCHANGE ST STE 107, MIDDLEBURY, VT 05753-4464
(802) 388-3553
(802) 388-7377
Mailing address
1330 EXCHANGE ST STE 107, MIDDLEBURY, VT 05753-4464
(802) 388-3553
(802) 388-7377
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
016.0068107
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016.0068107
VERMONT STATE LICENSE
VT
Enumeration date
06/17/2010
Last updated
06/17/2010
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